Medication Safety- Nursing Insight for Patient Empowerment

Medications are taken to treat or prevent disease. Yet while individuals try to take care of their health, each year more than a million emergency department visits and 350,000 hospitalizations are attributed to adverse drug events. 

It’s a statistic we wish didn’t exist.  

82% of American adults take at least one medication, and 29% take five or more. This means that addressing medication safety should be a top priority for each one of us. Even if you’re not part of these statistics, you likely have a loved one that is: making medication safety worthy of your attention. 

As a critical care nurse, I know firsthand that medication safety is a priority for both individual healthcare professionals and organizations as a whole. There are countless committees and task forces working to make safety improvements. And the statistics still show that we need to do better.

Through knowledge and action steps, the purpose of this article is to activate a missing link in medication safety: empowerment of the patient. Let’s get started building a framework for safety with medication use. 

First, we must be aware of the various types of adverse events:

1. Human Errors
2. System Errors
3. Adverse Effects
4. Drug Interactions 
5. Adherence Barriers 

Does this feel like reading a human resources manual? Unfortunately, the statistics reflect a very limited impact of only administrative professionals working toward medication safety. So think of learning medication safety like going to the DMV; there are preferred ways to spend your time, but it has to be done to use the system safely and efficiently. 

Like new automations for the DMV, I will focus only on the necessary elements of medication safety, without requiring you to wait in line. 

Human Errors

Human errors occur everywhere from prescribers, pharmacies, nursing and care providers, and finally: patients.  

There are 3 ways to protect yourself from human errors with medications:

1. Know Your Medications

Beyond what the prescription label reads, you must know why you take each medication and any significant side effects. Include these on your medication list (which we’re all keeping up to date, right?).  

Keep it short and sweet. For example, you can write:

• for high blood pressure
• bleeding risk
• fall risk 

The term “polypharmacy” refers the use of several prescriptions— usually defined as five or more. This can lead to increased risk of falls, confusion, and other adverse effects. If you have the same risk listed for multiple medications, ask about it! Know if or why it’s appropriate to have compounded risks with those medications. This goes a long way to protect from polypharmacy risks, especially in the aging population. 

2. Verify Your Medications 

With every new prescription and refill, read on the label what the pill should look like and compare it to what you see in the bottle. Additionally, every time you are handed a pill, even by a healthcare professional, ask what it is.  

Patients often apologize when they question their medications in the hospital, but as a nurse, I can assure you that we love when you do this!

You should always know what you take, whether at home or in the hospital. And always remember that no one, even medical professionals, is immune from human error. 

3. Know Who Is in Charge of Your Healthcare Decisions

You are the authority on your healthcare decisions.  

However, your doctor can help you implement your decisions safely if you don’t want to continue a medication or don’t think you need it. 

Many harmful medication events occur when a prescription is started but not followed through or not safely stopped or changed.  

Your doctor prescribes medications that are shown to improve disease outcomes with more known benefits than risks. Many patients mistakenly view the doctor’s orders as written in stone and authoritarian in intent, but remember, your doctor doesn’t know what side effects concern you most unless you speak up. Additionally, your doctor doesn’t know your interest in alternative options unless you share your thoughts. 

Be active in the dialogue about your prescriptions. Question “Doctor’s Orders.” 

Your doctor will be proud. 

Not excited about the prospect of that type of conversation? Ask a loved one to be with you or a nurse advocate. Or try one of these lines to get you started–

• “I want to understand this better.”
• “I understand you recommend this, but I feel _____. What are the alternatives?” 
• “I don’t want to take this anymore. What is the safest way to discontinue it?” 
• “I realize your schedule is busy. Do you have a nurse available to spend time with me to help me better understand my prescriptions?” 

Your doctor has the education and expertise to assess your condition and prescribe medications. Still, medication use is safer with a patient empowered to question, discuss, and understand their prescriptions.  

System Errors

In the electronic record era, there are medication safeguards built-in. Yay, right?

Almost. 

Along with many protections, these systems can also cause false assurances and a distracted focus. 

3 ways to protect yourself from system errors with medications include:

1. Perform a Double-Check

Bring your medication list to every doctor’s appointment and any time you visit the hospital. Ask that it be compared to what’s on the computer to verify that both are up to date.  

Decision making is affected by the medication list that a healthcare professional is looking at. Wouldn’t it be cool if they were all linked and updated together? 

It’s getting closer, but errors transitioning from “phases of care” (ex., hospital to rehab to home) significantly contribute to the medication safety crisis. However, you can mitigate some of this risk by performing a quick check at each appointment, hospitalization, or change in provider. 

2. Use One Pharmacy

Getting your medications at a single pharmacy allows for important safety checks by the pharmacist. If a prescription requires a specialty pharmacy, make sure that your primary pharmacy knows about these medications. Even more, you should update your pharmacy of anything you take over the counter. 

Your pharmacist needs to know all medications you take for the built-in safeguards to work. If in doubt, ask to speak to the pharmacist.  

Remember that you can’t assume the information in the system is correct and complete.  

3. Have A Primary Care Doctor

Your primary care doctor should be viewed similarly to the “one pharmacy plan.” This physician is the one who takes a broad view of your healthcare with input from any specialties involved.  

Medical appointments can be tedious— Cardiologist for blood pressure–check!

Dermatologist to stay proactive–check! Primary care…. 

Skipping primary care because you feel like your concerns are managed by the specialists you see is a mistake. Specialists are experts in their field, but that focus is narrowed. Primary care doctors are valuable in your healthcare team and critical to medication safety. 

An elderly relative of mine had a situation where his heart function would benefit from lower blood pressure, but his kidney function would benefit from higher blood pressure. The medication orders from these two specialties were conflicting. Luckily, the primary care provider clarified his personal priorities and goals to navigate the decisions. 

Our body systems are interdependent, and your primary care physician has the crucial role of managing the interactions of these systems in your healthcare. Safe medication use depends on it. 

Adverse Effects

These are not errors, yet they can be equally impactful. Also known as side effects, these are effects from medications other than their intended purpose. They range in severity but can have a compounding effect when you take multiple medications. 

Some adverse effects can include:

• fall risk
• dizziness
• bleeding risk 
• constipation

Know your medications’ side effects, and discuss the ones that concern you. 

Ask about alternatives if you are not okay with the side effects. Ask your doctor about the risks vs. benefits to help with decision-making. Pay attention to any side effects that are duplicated with different medications you take because that increases the risk level. 

Be knowledgeable and curious about the medications you take and their effects on your health.

Drug Interactions

These refer to how different medications affect each other and also how foods can affect some medications. Get comfortable with the question “Are there any food or drug interactions with these medications?” and ask it any time you are prescribed a new medication.

Drug interactions can range in severity from ‘something to be aware of’ to ‘these cannot be taken together.’

Make a note of interaction risks on your medication list. This not only reminds you of them but also alerts every healthcare professional who views your list, which (remember!) should go with you to every appointment or hospitalization.

Adherence Barriers

Sticking to the plan you develop with your doctor is vital for using medications safely. 

For example, stopping an antibiotic too soon can cause a much more severe infection. The resulting sepsis response by the body can be life-threatening. 

Skipping doses of blood pressure medication can cause dangerous fluctuations. Sadly, I can’t count how many patients I have cared for with bleeding in their brain (hemorrhagic stroke) due to uncontrolled high blood pressure. Many had been prescribed blood pressure medication that they didn’t take as ordered. 

Doctors, pharmacists, and patients must work together to address anything limiting your ability or desire to take medications exactly as prescribed.  

And I don’t mean strategies to make you “compliant.” I am not here for institutional ratings and the safety metrics that shift responsibility. 

The dialogues I have recommended so far should give you a good idea of how I believe healthcare should work with you. If you can’t or don’t want to follow a prescription, talk to your doctor about it so that you can work together to individualize your care. Work with a healthcare advocate if you don’t feel heard or understood. Often, help with communicating your perspective can improve collaboration with your healthcare team. 

Address your concerns about side effects. 

Use pill organizers to ensure you take the right pills each day and have a visual confirmation that you did. Reminder apps or a simple alarm on your phone can help you remember to take them.  

Address cost barriers— Join my email list to gain strategies for Tackling Medication Costs in my upcoming article. vallationhealth.com/signup

Recap: 

Safe medication use requires an active role in safeguarding your well-being. You hold the power to mitigate risks from human errors, systems errors, adverse effects, drug interactions, and adherence challenges. 

Keep the Following in Mind:

• Know your medications.
• Understand their side effects.
• Engage in open dialogues with your healthcare providers.
• Feel welcome to question “Doctor’s Orders” and seek alternatives when necessary.
• Keep an up-to-date medication list.
• Rely on a single pharmacy.
• Involve your primary care doctor in your overall healthcare. 

By staying informed, addressing concerns, and working with your healthcare providers, you can more safely use medications to disrupt disease processes and enhance your quality of life. 

If you would like a professional medication management consultation, visit vallationhealth.com/consultation to connect with me.

You may also email info@vallationhealth.com with questions or inquiries about concierge healthcare coordination.